Abstract 17118: Isolated Diastolic Hypotension Without Systolic Hypotension or Hypertension is an Independent Risk Factor for Incident Heart Failure Among Community-Dwelling Older Adults
Background: We have previously demonstrated that isolated diastolic hypotension (IDH), as defined by diastolic blood pressure (DBP) <60 mm Hg with systolic blood pressure (SBP) >100 mm Hg, is a significant independent risk factor for incident heart failure (HF) in older adults with and without hypertension (2010 ACC Abstract 1241-109). However, confounding by systolic hypertension was a concern and whether this association would persist in those without hypertension remained unclear.
Methods: Of the 5795 community-dwelling older adults, age ≥65 years, in the public-use copy of the Cardiovascular Health Study data obtained from the National Heart, Lung and Blood Institute, 3298 had SBP between 100 and 139 mm Hg, of whom 594 (19%) had IDH (DBP <60 mm Hg). Propensity scores for IDH, calculated for each of the 3298 participants, were used to assemble a matched cohort of 548 pairs of individuals with and without IDH who were balanced on 40 baseline characteristics.
Results: Matched participants had a mean (±SD) age of 73 (±5) years, 62% were women, and 7% were African American. Matched participants with and without IDH had a mean SBP of 120.0 and 120.3 mm Hg respectively (p=0.618). Centrally-adjudicated incident HF occurred in 23% and 16% of matched participants with and without IDH respectively (matched HR, 1.47; 95% CI, 1.12-1.93; p=0.005; Figure). IDH had no significant association with all-cause mortality among matched participants (matched HR, 1.18; 95% CI, 0.99-1.42; p=0.067).
Conclusion: Among community dwelling older adults, isolated diastolic hypotension, in the absence of systolic hypotension or hypertension, was associated with a significant increased risk of new-onset HF but had no significant association with all-cause mortality.
- © 2011 by American Heart Association, Inc.